causes of failure of Root Canal Treatment a brief riview
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Causes of endodontic
failureDr.Taj Mahmood
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INDICATIONS
• Failure of root canal treatment is indicated in following conditions
a)Post treatment persistent lesionb)An increase in size of pre-existing
lesionc)Pain, swelling and loss of functiond)Sinus tracte)Signs of root resorption and
hypercementosis
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CAUSES OF FAILURE OF ENDODONTICS
• EXTRA RADICULAR
• INTRA RADICULAR
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EXTRA RADICULAR FACTORS
1.Microbial causeAbcess periapical periodontitisOverinstrumentationInfected periapical pocket cyst
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EXTRA RADICULAR FACTORS
2.Non microbial causesForeign bodies
Gutta perchaTemporary filling materialBroken instrumentSealersCotton fibrils
Treatment ; surgical removal of irritant
Cholestrol crystalsTrue cystScar tissue healing
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INTRARADICULAR FACTORS
They may be1. Preoperative2. Operative3. Post operative
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• PREOPERATIVEMisdiagnosis
lack of informationPoor case selection
Un-negotiable canal, resorption, unrestorable tooth, secondarily
periodontal involvementocclusal trauma apical abscess or cyst
Poor prognosisavulsed tooth, unsuccessful
treatment of endo-perio lesion
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• OPERATIVE FACTORS1.Failure to obtain biologic objective
a)improper removal of irritantb)debris pushed beyond the apical foramen
2.Failure to obtain mechanical objectivesa)improper access cavity preparationb)mishaps during canal preparation
short or excess preparation ledgeperforationtransportationmissed canalszipping, elbow formation apical blockage separated instrument
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OPERATIVE FACTORS
c)improper obturationunderobturation or
overobturation3.other causes
irrigant related mishapstissue emphysema
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POSTOPERATIVE FACTORS
• Post operative TraumaFractureSuper imposed non-endodontic lesionPoorly designd final restoration
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TREATMENT OPTIONS
• Best is prevention in each and every step of root canal preparation
• Proper diagnosis and treatment planning• Predecide the curving of canals and the
number of root canals• Adequate access cavity and avoid
perforation and too much destruction of structure of tooth
• Proper control of instruments and avoid excessive force
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TREATMENT OPTIONS
• Work in a proper sequence while filing
• Avoid in exerting too much force• Go to surgical removal of lesion and
irritant if necessary or medicate the patient
• Always be relax and comfortable to handle the complication
• If very poor prognosis is indicated then go for extraction